Neonatal outcome of inborn and outborn extremely low birth weight infants: relevance of perinatal factors. 2008

Ilan Arad, and Rony Braunstein, and Benjamin Bar-Oz
Department of Neonatology and Center for Safety and Quality, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. arad@hadassah.org.il

BACKGROUND A substantial number of premature deliveries occur in hospitals lacking neonatal intensive care facilities. We previously demonstrated a comparable outcome of very low birth weight infants delivered in a level II nursery to that of inborn infants delivered in our tertiary care center, but a similar comparison of extremely low birth weight infants has not been done. OBJECTIVE To compare the neonatal outcome (mortality, severe intraventricular hemorrhage/periventricular leukomalacia, bronchopulmonary dysplasia and intact survival) of inborn and outborn ELBW infants, accounting for sociodemographic, obstetric and perinatal variables. METHODS We compared 97 ELBW infants (birth weight < or = 1000 g) delivered between the years 2000 and 2004 in a hospital providing neonatal intensive care to 53 ELBW babies delivered in a referring hospital. A univariate model was first applied to examine the associations of the individual independent variables with the outcome variable, followed by a logistic stepwise regression analysis for each of the outcome variables. The odds ratios for each predictor were reported as well as their P values and 95% confidence intervals. RESULTS In the stepwise logistic regression analysis, accounting for a possible confounding effect of the independent variables, 'hospital of birth' remained a statistically significant predictor in the final step only for mortality, with odds ratio (inborns relative to outborns) of 3.32 (95% CI 1.19-9.28, P = 0.022). No statistically significant associations with the other outcome variables were found (severe IVH/PVL odds ratio = 1.99, 95% CI = 0.77-5.14, P = 0.155; BPD odds ratio = 0.60, 95% CI = 0.19-1.91, P= 0.384; intact survival OR = 0.56, 95% CI = 0.23-1.35, P = 0.195). CONCLUSIONS ELBW outborn infants may share an outcome comparable with that of inborn babies, if adequate perinatal care is provided.

UI MeSH Term Description Entries
D007226 Infant Mortality Postnatal deaths from BIRTH to 365 days after birth in a given population. Postneonatal mortality represents deaths between 28 days and 365 days after birth (as defined by National Center for Health Statistics). Neonatal mortality represents deaths from birth to 27 days after birth. Neonatal Mortality,Mortality, Infant,Postneonatal Mortality,Infant Mortalities,Mortalities, Infant,Mortalities, Neonatal,Mortalities, Postneonatal,Mortality, Neonatal,Mortality, Postneonatal,Neonatal Mortalities,Postneonatal Mortalities
D007229 Infant Welfare Organized efforts by communities or organizations to improve the health and well-being of infants. Infant Well-Being,Newborn Infant Welfare,Newborn Infant Well-Being,Welfare of Infants,Welfare of Newborn Infants,Infant Well Being,Infant Well-Being, Newborn,Infants Welfare,Newborn Infant Well Being,Welfare, Infant,Welfare, Newborn Infant,Well-Being, Infant,Well-Being, Newborn Infant
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D007363 Intensive Care Units, Neonatal Hospital units providing continuing surveillance and care to acutely ill newborn infants. Neonatal Intensive Care Unit,Neonatal Intensive Care Units,Newborn Intensive Care Unit,Newborn Intensive Care Units,ICU, Neonatal,Neonatal ICU,Newborn ICU,Newborn Intensive Care Units (NICU),ICU, Newborn,ICUs, Neonatal,ICUs, Newborn,Neonatal ICUs,Newborn ICUs
D007969 Leukomalacia, Periventricular Degeneration of white matter adjacent to the CEREBRAL VENTRICLES following cerebral hypoxia or BRAIN ISCHEMIA in neonates. The condition primarily affects white matter in the perfusion zone between superficial and deep branches of the MIDDLE CEREBRAL ARTERY. Clinical manifestations include VISION DISORDERS; CEREBRAL PALSY; PARAPLEGIA; SEIZURES; and cognitive disorders. (From Adams et al., Principles of Neurology, 6th ed, p1021; Joynt, Clinical Neurology, 1997, Ch4, pp30-1) Cystic Periventricular Leukomalacia,Encephalomalacia, Periventricular,Neonatal Cerebral Leukomalacia,Periventricular Leukomalacia,Leucomalacia, Periventricular,Cerebral Leukomalacia, Neonatal,Cerebral Leukomalacias, Neonatal,Cystic Periventricular Leukomalacias,Encephalomalacias, Periventricular,Leucomalacias, Periventricular,Leukomalacia, Cystic Periventricular,Leukomalacia, Neonatal Cerebral,Leukomalacias, Cystic Periventricular,Leukomalacias, Neonatal Cerebral,Leukomalacias, Periventricular,Neonatal Cerebral Leukomalacias,Periventricular Encephalomalacia,Periventricular Encephalomalacias,Periventricular Leucomalacia,Periventricular Leucomalacias,Periventricular Leukomalacia, Cystic,Periventricular Leukomalacias,Periventricular Leukomalacias, Cystic
D008297 Male Males
D001997 Bronchopulmonary Dysplasia A chronic lung disease developed after OXYGEN INHALATION THERAPY or mechanical ventilation (VENTILATION, MECHANICAL) usually occurring in certain premature infants (INFANT, PREMATURE) or newborn infants with respiratory distress syndrome (RESPIRATORY DISTRESS SYNDROME, NEWBORN). Histologically, it is characterized by the unusual abnormalities of the bronchioles, such as METAPLASIA, decrease in alveolar number, and formation of CYSTS. Dysplasia, Bronchopulmonary
D002543 Cerebral Hemorrhage Bleeding into one or both CEREBRAL HEMISPHERES including the BASAL GANGLIA and the CEREBRAL CORTEX. It is often associated with HYPERTENSION and CRANIOCEREBRAL TRAUMA. Brain Hemorrhage, Cerebral,Cerebral Parenchymal Hemorrhage,Hemorrhage, Cerebral,Intracerebral Hemorrhage,Hemorrhage, Cerebrum,Brain Hemorrhages, Cerebral,Cerebral Brain Hemorrhage,Cerebral Brain Hemorrhages,Cerebral Hemorrhages,Cerebral Parenchymal Hemorrhages,Cerebrum Hemorrhage,Cerebrum Hemorrhages,Hemorrhage, Cerebral Brain,Hemorrhage, Cerebral Parenchymal,Hemorrhage, Intracerebral,Hemorrhages, Cerebral,Hemorrhages, Cerebral Brain,Hemorrhages, Cerebral Parenchymal,Hemorrhages, Cerebrum,Hemorrhages, Intracerebral,Intracerebral Hemorrhages,Parenchymal Hemorrhage, Cerebral,Parenchymal Hemorrhages, Cerebral
D002552 Cerebral Ventricles Four CSF-filled (see CEREBROSPINAL FLUID) cavities within the cerebral hemispheres (LATERAL VENTRICLES), in the midline (THIRD VENTRICLE) and within the PONS and MEDULLA OBLONGATA (FOURTH VENTRICLE). Foramen of Monro,Cerebral Ventricular System,Cerebral Ventricle,Cerebral Ventricular Systems,Monro Foramen,System, Cerebral Ventricular,Systems, Cerebral Ventricular,Ventricle, Cerebral,Ventricles, Cerebral,Ventricular System, Cerebral,Ventricular Systems, Cerebral
D005260 Female Females

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